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high country backpack concerns
Sep 29, 2016

I'm taking a group of 20 somethings on an intense backpack trip in Asia. It's 7 days in high elevation, like 13,000-14,000 feet. We carry 35 pound packs. It is designed to be physically demanding. Over there it is just local guides helping us. There is no emergency evac services in case things go wrong. So, with elevation, and the physical challenges, would there be any concerns bringing one of the guys who is HIV positive? It seems he does not take meds now (not sure why), and he does not want to be re-tested to get his numbers(he says it would stress him out). As a leader I'm concerned and want to know if you have advice for a leader of these treks. On the medical side I am seeking a professional's opinion, and I am trying to find out more about this participants situation. I don't want to over-react, but neither do I want to be unconcerned. Up there, if anything goes wrong it affects the entire group. And as of now only 3 of the 20 guys know about this man's condition. All the participants are Asian. Thank you. I recently read about a woman who backpacked the Appalachians for months. But the difference with us is our high elevation and there is no easy way out. Guides would have to contact other local guides in an emergency. Last trek we had a guy have a cut on his hand and he bled a lot. We had to bandage it several times and injury is a concern too. So lots of thoughts...physical endurance, meds, diet, properly treating cuts, informing the entire team and guide, altitude sickness...

Response from Mr. Vergel

Many people living with HIV are as healthy as HIV negatives, especially after our HIV viral load is controlled by medications.

I understand your concern. I would be concerned also since he seems not to be taking any HIV antiretrovirals. He may have high CD4 cells which may make him less prone to opportunistic infections, but he may not. Big dilemma of which I think you are entitled to get to the bottom.

What concerns about me is that you have not mentioned how you screen participants to ensure that they do not ruin the trip for everyone else. Do you have them take some sort of physical or endurance exam? How do you know if any of the HIV negatives are capable to endure that trip? Anyone with high blood pressure or cardiovascular disease that will suffer of altitude sickness or even a heart attack?

Unless you are able to proof that the HIV positive person presents a liability to others, not allowing him would be seen as discrimination unless he does not pass some sort of standard test that you provide to screen fitness, endurance, etc. Asking for a doctor's release letter could also help.

I would be feeling apprehensive to hear that someone does not know their CD4 cell count and viral load before leaving the country for a remote place that could present health challenges. Having an undetectable viral load would make it nearly impossible to infect anyone exposed to someone's bleeding cut.

You say 3 people know about this situation. Would others treat the HIV positive person with stigma when they find out? Would this create issues for you as a trek leader? I am sure team cohesion is important when you are in the middle of nowhere.

Does your industry have guidelines for assessment of participant's health before a trip?

I would seek guidelines and legal advice, two things I have no idea about.

Good luck in your decision and how you handle it.

Nelson


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